Encapsulating peritonitis and familial Mediterranean fever

Area of Science:

• Gastroenterology
• Immunology
• Surgical Pathology

Background:

• Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent episodes of fever and serositis.
• Encapsulating peritoneal sclerosis (EPS) is a rare condition involving inflammation and fibrosis of the peritoneum, often associated with long-term peritoneal dialysis or certain medications.
• The potential link between FMF and EPS, particularly in cases involving foreign bodies, remains underexplored.

Observation:

• A patient with a history of type 2 diabetes and cholelithiasis developed massive ascites 11 months post-laparoscopic cholecystectomy.
• Ascitic fluid analysis revealed exudative characteristics, and imaging showed omental thickening and ascites.
• Exploratory laparotomy identified a laparoscopic clip encapsulated by fibrous tissue, with biopsies ruling out malignancy.

Findings:

• Histopathological evaluation indicated chronic nonspecific inflammation and mesothelial proliferation.
• The patient was diagnosed with sclerosing encapsulating peritonitis, likely induced by the laparoscopic clip.
• The presence of FMF in the patient suggested a potentially exaggerated immune response contributing to the condition.

Implications:

• This case suggests that FMF may predispose individuals to a more severe or atypical presentation of foreign body-induced encapsulating peritonitis.
• Further research is warranted to elucidate the immunological mechanisms underlying this interaction.
• Understanding this relationship could inform clinical management strategies for FMF patients experiencing peritoneal complications.